Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT003926 | GA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT003926 | GA |
NPI | 1225198963 |
---|---|
Provider Name | Mrs. Dedrika Ashmore Johnson |
First Address | Buford, GA 30519-8081 |
Second Address | Demorest, GA 30535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |